Step 2CS Qs

[Amicr01]

Hi everyone,
I'm taking CS soon and am incredibly stressed. In reading over the CS official guide and watching the video I had a couple of questions that I hoped someone might be able to answer.

FA mentions in the minicases to measure orthostatics for loss of consciousness and GI bleeds. Is it sufficient to just measure HR supine and upright? If not under what circumstances should you also measure BP supine and upright? ( I'm so slow at measuring BP)


Also Kaplan core cases suggests that if you run out of time to say 'I'm sorry I have an emergency page to answer. I'll be back later'. Did anyone say something similar if they ran out of time. Could this ever be interpreted as inappropriate conduct because you are continuing to engage the SP after the encounter is over?

Thanks so much in advance!


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[doyouhaveaflag]

I can't imagine taking the time to do orthostatic vitals. If you think it would help you in the diagnosis, I would put it in the workup section on the note (along with banned PE maneuvers). Having time to close is way more important.

I don't think it matters if you say anything once time is called, but make sure you get out of there quickly. All but one person in my group were out before time was called on most cases, but there was one girl who didn't exit the room until 20-30 seconds afterwards for two of the stations and the proctor came over and gave her an official warning that she'd get cited for irregular behavior if she did it again. So, perhaps it's better just to walk out.

 

[DBV]

I didn't think to do orthostatics. They're going to be normal because the person is not really having whatever problem. Hopefully I don't get knocked too hard for stuff like this.

 

[iBS1972]

I would put money on that you're not expected to do an orthostatic vitals exam.

A proper measurement of orthostatic blood pressure requires the patient to lie down for 5 minutes, then measure BP and pulse, then stand and remeasure BP and pulse after 1 and 3 minutes of standing.

 

[Applepieisgood]

I dont ever remember seeing a BP cuff in an exam room for CS. Also, if it comes to it just dont do it its likely just 1 check mark, and on the paper just write you would have done it if you had more time. As a last resort if you know you need it just do the upright one at the start while asking questions, and the flat one when you start the P/E. I highly doubt you will get it, it takes way too long and your suppose to wait a few minutes in between lol, this should be the least of your worries believe me

 

[Applepieisgood]

Also i ran out of time i couple of stations and i just said - Thank you so much for your time, if you have any more questions or need anything let the nurse know i would be happy to help you and i will check up on you later". I had higher performance on CIS

 

[iBS1972]

I'm currently reading the First Aid step 2 CS book. In each of the practice cases, there's a short paragraph for closing, that is you telling the patient what you think the diagnosis is and what tests you're going to order, as well as the counseling. I know the counseling is required, but are the other stuff required as well--the telling the patient the likely diagnosis and what tests you recommend? Is it enough to just thank the patient for speaking with you and ask if they wanted to say/ask you anything that hasn't been addressed already? Thanks guys.

 

[Ismet]

I'm currently reading the First Aid step 2 CS book. In each of the practice cases, there's a short paragraph for closing, that is you telling the patient what you think the diagnosis is and what tests you're going to order, as well as the counseling. I know the counseling is required, but are the other stuff required as well--the telling the patient the likely diagnosis and what tests you recommend? Is it enough to just thank the patient for speaking with you and ask if they wanted to say/ask you anything that hasn't been addressed already? Thanks guys.

You're supposed to tell them what you think is going on and the next steps. They always have a "challenge" question for you.

It would be pretty awkward to do a full H&P and then walk out of the room without giving the patient some kind of answer as to what you think is going on with them. You'd lose major CIS points.

 

[iBS1972]

Thanks for your response, and it makes sense.

I was wondering if people shotgunned questions during their CS, in that asking about more than one thing at a time. Like, "any nausea or vomiting" "any headache or dizziness" "any medical conditions you know of, like high BP, DM, or HLD?" We were always discouraged to this during our OSCEs, but I just thought it was better to get through all the questions (esp. since I know the answer's probably no) than ask one at a time and risk running out of time.

 

[breadlover72]

For orthostatics, somewhere, I believe in a video or instructions, it said if needed they will be listed for you. However, that being said, I might have a case where my first diagnosis probably would have required them. They weren't listed. I didn't do them though. I didn't mention needing them either. And I passed. Take with a grain of salt though cause it's all so subjective.

I only ran out of time on my very last case to answer a challenge question and I said "thank you so much for providing me with all your information, we will get these tests I mentioned started and I will be back to check on you and answer your question."
You have to be quick or they'll pull you out of the room. That's the best I could come up with at the time and I passed CIS on the much higher side.

Thanks for your response, and it makes sense.

I was wondering if people shotgunned questions during their CS, in that asking about more than one thing at a time. Like, "any nausea or vomiting" "any headache or dizziness" "any medical conditions you know of, like high BP, DM, or HLD?" We were always discouraged to this during our OSCEs, but I just thought it was better to get through all the questions (esp. since I know the answer's probably no) than ask one at a time and risk running out of time.

Don't shotgun questions. You have to ask one at a time. If you ask this or that they are trained to respond regarding the "that" and you could miss something.

 

[darklabel]

Just to further add above, they are trained to answer quickly. So just say "Do you have any nausea" they'll respond quickly with a "No". Be wary that they can answer yes to something and it will be like pulling teeth to get them to respond to you.

Also idk why it keeps coming up but no one should do orthostatics. Just list it as something you have to do and bring it up when you're summarizing but you have a very limited amount of time and it's something that will take up a LOT of your time. IMO the cuff is there to just throw you off since no one should be taking any BP.

 

[W19]

Does the first HPI paragraph have to be long? Mine is usually 4 lines, and someone told me it has to be 6+ lines.

It's sad to see I might fail that test because of typing issues (~28 wpm)...